• Preface
• Introduction
• General Description Of The Ccsi
• Historical Background
• Purpose
• Applications
• Benefits
• Administration
• General Instructions
• Background Information
• Symptom Rating
• Annotation
• Etiology Scales
• Scale Development
• Etiology Scales
• Scoring And Charting
• Electronic Format
• Manual Format
• Interpretation
• Symptoms, Scales And Global Assessment
• Creating A Report
• Psychometric Properties
• Validity
• Reliability
• Bibliography

    This is a manual for implementation of the Cayce Comprehensive Symptom Inventory (CCSI) in a clinical setting.  It is based, primarily, on the psychic readings of Edgar Cayce.  Mr. Cayce is widely regarded as the father of modern holistic medicine.  The expansive body of information which came through Edgar Cayce addresses the full range of the human condition - physical, mental, and spiritual.  With regard to health and illness, Cayce's intuitive process shed light on the full spectrum of illness - from wellness to "dis-ease," to the most severe and disabling conditions.

    Illness does not always fit easily into a diagnostic category.  Sometimes an individual may be labeled with multiple diagnoses which are obviously related, yet regular medicine does not make the connection between the diverse symptoms.  The CCSI is an attempt to look behind the symptoms to understand the complex patterns of cause and effect which are unique to each person at any given point in time.

    Thus, the "person-centered" approach focuses on the uniqueness of each individual rather than a diagnostic category.  Edgar Cayce preferred the person-centered approach.  Generally speaking, he chose to give psychic readings for individuals rather than for diagnostic categories.  Likewise, the CCSI is an attempt to learn about the unique of each person and translate that information into useful clinical practice.

GENERAL DESCRIPTION OF THE CCSI

    The Cayce Comprehensive Symptom Inventory (CCSI), is a structured assessment instrument intended for use as an adjunct to traditional and alternative assessment procedures.  The CCSI consists of a wide variety of signs and symptoms of physical and emotional distress.  The items are arranged in scales, each scale representing a pattern of etiology (cause and effect) used by Edgar Cayce in his system of assessment and diagnosis.  The Etiology Scales can be grouped into four general categories:

1)  Blood and Circulation,
2)  Nervous Systems, and
3)  Functioning Organs.
4)  Psychospiritual

    Essentially, individuals taking the CCSI are asked to rate the presence of the sign or symptom during the past twelve months.  Some items are retrospective, requiring information preceding the previous twelve month period.  Based on the responses, the electronic version of the CCSI calculates and produces tables and graphs representing the Etiology Scales.

HISTORICAL BACKGROUND

    Edgar Cayce (1877 - 1945) was an intuitive diagnostician widely regarded as the father of modern holistic medicine.  During his career, he gave "psychic readings" for thousands of individuals who sought his services.  Although many of the early readings were not recorded, 14,145 were stenographically transcribed and have been preserved by the Association for Research and Enlightenment (A.R.E.) in Virginia Beach, Virginia.  The Complete Edgar Cayce Readings on CD-ROM is a collection of the Cayce readings.  This computerized version of Cayce's work was the primary database in the development of the CCSI as described below.

     As an indication of Cayce's interest in providing help to persons stricken with physical illness, over 9,000 readings were given for individuals suffering from various ailments.  When the therapeutic recommendations provided in the readings were followed consistently, many people reported improvement in their condition.  Some individuals claimed significant healing even in cases involving serious and incurable disease.

    Since Cayce's death in 1945, the vast collection of information in his readings has been applied by thousands of persons for a wide variety of problems.  In most instances, the afflicted individuals were following the advice in readings Cayce had given for other persons with similar symptoms.  In the absence of Edgar Cayce to provide the diagnosis and treatment plan, and no individuals coming forward with skills comparable to Cayce, the A.R.E. made available collections of readings on specific topics (such as disease categories).  In addition to these "circulating files," research bulletins, disease protocols, and books on the Cayce health information have been published to explain  Cayce's readings and assist individuals in working with the material.  The CCSI, Version 1.0 was developed in 1998 by David McMillin to provide an additional resource for persons wishing to apply the Cayce approach.

PURPOSE

    In a sense, the CCSI is a crude attempt at replicating the assessment process of Edgar Cayce by utilizing etiological and pathophysiological language and constructs from the Cayce readings and the medical literature of Cayce's era.  Whenever possible, terminology and perspectives from the early osteopathic literature are cited to provide a conceptual and historical context for the Cayce information.

• The CCSI is intended primarily for practitioners of the Cayce Health System.
• The CCSI is intended as an adjunct to physical examination and clinical interview including a thorough history.
• The CCSI is not intended as the sole assessment and treatment planning procedure.

    The CCSI can be utilized in various ways, including:

• Structured Clinical Interview - Simply going through the inventory with a client will provide a standardized format for gathering essential data and getting to know the person as an individual.
• Individualized Treatment Planning -  In combination with clinical judgment, the inventory can point to therapeutic options which can be incorporated into an individualized treatment plan.
• Hypothesis Development - The inventory can be especially helpful in providing hypotheses on causation and treatment for clients who do not fit conveniently into a standard diagnostic framework or for whom standard treatment has not been effective.
• Screening For Further Assessment - The inventory can serve as a screening tool to help the clinician decide upon the need for further assessment in specific areas (e.g., blood work, psychological assessment, manual assessment, etc.).
• Outcome Evaluation - The inventory has the potential to provide outcome assessment data which can be helpful in tracking the healing process from a systemic standpoint.
• Research - The inventory may be utilized as a research tool, particularly with regard to exploring the concepts in the Edgar Cayce health information.

    The CCSI offers the following benefits:

• Low Cost - The CCSI is an inexpensive means of collecting and analyzing large amounts of information about clients.
• Simple - The CCSI is designed to be intuitive with regard to administration and scoring.  In other words, practitioners do not need to spend a great deal of time learning how to use it.  The electronic format of the CCSI automatically tabulates and graphs the results to further simplify the process.
• Noninvasive - The CCSI has the potential for providing useful information about anatomy and physiology which would otherwise require rather invasive assessment procedures.
• Therapeutic Options - The CCSI scales list therapeutic options which Edgar Cayce recommended for particular pathophysiological patterns.  These options may be useful during the development of an individualized treatment plan.

GENERAL INSTRUCTIONS

    The CCSI can be administered electronically or manually.  The electronic administration is preferred as it will automatically produce summary scores and graphs for the Etiological Scales.  This saves time and reduces the chance of mathematical error.  The manual administration requires simple math skills such as addition and division.

    Begin the administration by explaining the purpose of the CCSI as described earlier in this manual.  Be sure to cover the following areas as part of the general introduction:

• Time - Inform the client as to the amount of time required for the inventory (usually about 30 minutes for the electronic version).
• Cost - Inform the client of any fees involved in administering the CCSI.
• Confidentiality - Inform the client that the information will remain confidential.  The information may be used for research purposes is the client so agrees, but the client's name or other identifying information will not be included in the data collection process.
• Limitations - Inform the client of limitations of the CCSI with regard to diagnosis and treatment planning.  At this point, the CCSI is primarily intended as a research tool and clinical adjunct to other assessment procedures.  One of the major uses of the CCSI is for hypothesis generation regarding causes and treatment options.

    For electronic administration, follow the simple instructions for opening the CCSI spreadsheet program as described in the instructions which come with the disk.

    For manual administration, you will need a pencil and copy of the CCSI.

BACKGROUND INFORMATION

    The CCSI requires the following background information:

• Name - Write or type the client's name at the top of the CSSI in the designated space.
• Date - Write or type the date of administration.

    Proceed with the administration by assigning a number for each symptom.  Here are some criteria for rating the severity of symptoms:

0 = No or None
    If the client has not had any problem with this symptom during the past 12 months, enter "0".

1 = Mild
    If the client is aware of having a problem with this symptom during the past 12 months but has not sought professional treatment it is probably a "mild" rating.  The client may be using an "over the counter medication" or some form of self-treatment.  Also, a mild level probably does not seriously affect quality of life or cause significant discomfort.  An examples of this level would be an occasional mild headache of sort duration.

2 = Moderate
    The client will probably seek treatment for the moderate level of a symptom because it is likely to adversely affect quality of life or cause notable discomfort.  The client may find that he/she avoids certain activities or is required to make adjustments in daily activities because of a moderate symptom.  The client probably has discussed the symptom with his/her doctor and received a prescription or some form of professional treatment.  An example of this level would be fairly frequent headaches or increasing pain levels that cause the client to miss work or other daily activities from time to time.

3 = Severe
    The client is very likely to seek treatment when a symptom is "severe."  Severe levels of symptomatology cause significant discomfort and adversely affect quality of life.  An example of this level would be chronic and debilitating headaches (such as migraine) that make it almost impossible to have a normal life.

    A Symptom Rating Guide has been created to assist in presenting the symptom and discriminating levels of severity.

ANNOTATION

    One of the primary objectives of the CCSI is to help the clinician to better understand the uniqueness of each individual being assessed.   Recognizing that the descriptions of symptoms listed in the CCSI may not exactly fit the experience of the client, annotation of variations of symptoms is desirable.  For example, a client may report that she often experiences a slight feeling of fever, but only during the late morning (about 11:00 am).  This would be worth documenting, either by handwritten notes or as electronic annotation.  The electronic version of the CCSI (Excel 97) provides a means of annotation by inserting "comments" into the body of the CCSI.  When the CCSI "Symptom" worksheet is printed, the annotations are automatically printed on the last page.

SCALE DEVELOPMENT

    The CCSI Etiological Scales are derived directly from the health readings given by Edgar Cayce.  Etiological patterns commonly cited by Cayce were researched using the Complete Edgar Cayce Readings on CD-ROM (Windows and DOS versions).  The most often noted symptoms for each pattern were compiled and are listed in the Documentation section of each Etiological Scale.

    In general, only the most frequently mentioned symptoms were included in the scale for each pattern.  However, in certain instances where a particular symptom was notably pathonomonic for the etiological pattern, that symptom is included in the scale even though it was less frequently cited by Cayce.

    When possible, the content of each scale was compared with other symptom rating scales to decrease the chance of unintentional omission.  However, all symptoms on the CCSI are derived directly from the Cayce readings as documented in the discussion of each scale.

ETIOLOGY SCALES

    The CCSI Etiology Scales are:

    1: Poor Superficial Circulation
    2: Cold Hepatic Circulation
    3: Gastric Hypoacidity
    4: Gastric Hyperacidity
    5: Systemic Hyperacidity
    6: Torpid (Sluggish) Liver
    7: Sensory System Dysfunction
    8: Kidney Dysfunction
    9: Systemic Toxicity
    10: Low Calcium
    11: Lack of Coagulation
    12: High Urea
    13: Stomach Position
    14: Intestinal Permeability
    15: Hypothyroid
    16: Voluntary/Involuntary Incoordination
    17: Lacteal Duct Adhesions
    18: Psychological
    19: Hypoadrenal
    20: High Hepatic Circulation
    21: Anemia
    22: After Effects of Intestinal Flu
    23: Gallbladder Dysfunction
    24: Respiratory System Dysfunction
    25: Brain Dysfunction
    26: Abnormal Heart Action
    27: Pancreatic Exocrine (Digestive) Dysfunction
    28: High Blood Sugar
    29: Spleen Dysfunction
    30: Reproductive System

ELECTRONIC FORMAT

    The electronic format of the CCSI is self-scoring.  The program automatically tabulates the score each time a symptom is assessed.  At the completion of the final item, a worksheet titled "Etiology" provides a summary of the scale scores and a graph illustrating the score for each scale.

MANUAL SCORING FORMAT

    Manual administration of the CCSI requires that you add up the total for each scale and perform some simple math.  Here are some guidelines for manual scoring:

• Some symptoms are particularly significant and must be multiplied by the factor to the left of the symptom.  For example, if a symptom has a "2X" associated with it, multiple the symptom score by 2 before adding it into the total for that scale.
• Calculate the total raw score by adding the final score of each symptom.
• Transfer each scale score to the summary table provided.
• Chart the scale score on the graph provided.
• A global score can be calculated by adding the scores for all scales and transfering to the Global Scale Graph.

SYMPTOMS, SCALES AND GLOBAL ASSESSMENT

    The CCSI can be interpreted at various levels.

• Symptoms - The severity of specific symptoms should be noted with particular attention to symptoms rated as "severe" (number 3).  From a clinical standpoint, these symptoms are clear signs of significant distress and should be considered when developing a treatment plan.  Edgar Cayce often included suggestions for symptomatic relief as well as treatments intended to address underlying causes.
• Etiology Scales - High scores on Etiological Scales are often indicative of systemic problems associated with the pathophysiological manifestations as represented by that scale.  The Cayce approach is very "systems" oriented.  The Etiological Scales are associated with physiological systems as described by Edgar Cayce.  Recognizing cause and effect patterns at the level of physiological systems will usually improve the chances of understanding the underlying causes of the client's condition.  Each Etiological Scale includes therapeutic options for persons with a high score for that scale.  From a treatment planning perspective, look for treatment recommendations which are common to the highest rated Etiological Scales.  These are probably the interventions which Edgar Cayce would prescribe for the individual at that point in time.  For example, if castor oil packs are included as therapeutic options on the three highest Etiological Scale scores, this is a likely therapeutic option to consider for the treatment plan.
• Global Assessment - Totaling the scores from the Etiological Scales will produce a "Global Score" which is a gross indicator of overall health or illness.  Edgar Cayce often spoke of a continuum of health ranging from optimal wellness to "dis-ease" to "disease."  The Global Score may provide a general sense of where the individual is on this continuum at the time of the assessment.

    The electronic version of the CCSI can be used to create a simple report based on the Etiological Scales.  Here are some simple instructions for generating a report:

• Locate the Etiological Scales summary table on the Etiology worksheet.
• Click on the heading "Scales" at the top of the table of etiology scales.  This will take you to the file containing the overviews of the various etiological scales.
• Click on the scale that you wish to use in your report.  This will take you to the brief overview of that scale.
• Using your mouse, highlight and copy the brief overview for the scale you wish to include in your report.
• Return to the CCSI spreadsheet.
• On the page after the Etiology Scales graph (or on any page where you wish to create the report), paste the brief overview of the desired scale.
• You may add as many of the brief overviews as you think appropriate depending upon the relevance of the scores.
• Add additional comments as appropriate with regard to the severity of specific symptoms or the Global Score.

VALIDITY

    In a general sense, validity refers to the issue of appropriateness.  Does the CCSI measure what it is intended to measure?   The primary purpose of the CCSI is to provide a psychometric tool which provides assessments of individuals which is comparable to the assessments provided by Edgar Cayce.  Not necessarily that the intuitive process of Mr. Cayce is being followed.  Rather, the output of information that is produced is somewhat similar.  In other words, can we evaluate an individual and provide descriptive and prescriptive information that would be comparable to that given by Edgar Cayce if he were alive today and gave a psychic reading for the same individual?  To the degree that the evaluation produced by the CCSI is representative of the Cayce approach it can be considered to have a degree of internal validity.  To the extent that the CCSI can be successfully applied to help suffering individuals, it can be said to have external validity.

    Two form of internal validity have been addressed in the development of the CCSI - 1) Face validity, and 2) content validity.  Face validity refers to how the instrument appears. Face validity relies on logical judgment or expert opinion that the procedure measures what it should.  In other words, does the instrument seem like a reasonable way to gain the information that we are attempting to obtain?

    With regard to expert opinion, the CCSI was developed by David McMillin who is:

• author of several books and computer programs on the Cayce health information,
• consultant to the Association for Research and Enlightenment (A.R.E.), the official organization dedicated to researching the Cayce material,
• program director of the Health and Rejuvenation Research Center (HRRC), a division of the A.R.E.
• president of the Meridian Institute, a research organization dedicated to researching the Cayce health information in a scientific manner.
• lecturer and instructor on the Cayce health readings.

    Content validity is based on the extent to which a measurement reflects the specific intended domain of content.  In other words, is the CCSI representative of the Cayce health readings?

    To enhance content validity, the following procedures were used in the development of the CCSI:

• the scales (etiological factors) of the CCSI are derived directly from the Cayce health readings, even to the extent of occasionally using outdated language (e.g., "torpid liver," "cold hepatic circulation," etc.) to describe the scale domains;
• all content items (symptoms) are documented as applying to the particular scale and included in a table in the Documentation section of that scale;
• only the content items that were most representative of a particular scale were included, either by sheer volume (number of times the symptoms was cited in relation to the scale), or by explicit linkage of the symptom to the scale by Cayce, implying a pathonomonic relation.

    External validity has not yet been demonstrated for the CCSI.  The CCSI is being utilized in small pilot projects conducted by the Meridian Institute.  Specifically, the following aspects of external validity are being considered:

• Concurrent validity - a number of similar psychometric instruments (especially in the field of "functional medicine") have been created which provide the opportunity to compare the CCSI to other psychometric tools such as symptom rating scales for etiological factors;
• Criterion validity - several of the scales of the CCSI lend themselves to comparison with external criteria (e.g., bowel permeability, gastric pH, blood urea nitrogen, etc.);
• Predictive validity - the question of whether the CCSI can accurately predict treatment outcomes is important and worthy of study.

RELIABILITY

    Reliability refers to consistency of measurement.  Presently, there is insufficient data on the CCSI, to determine the reliability of the instrument.

   The following books are sold at many bookstores and can be purchased from the A.R.E. Bookstore at (800) 723-1112.  The A.R.E. Library in Virginia Beach, Virginia also makes them available to A.R.E. members.  The CD-ROM is sold through the A.R.E. Bookstore.

Books About Edgar Cayce:

Bro, H.  A Seer Out of Season.  New York: Penguin Books.

Smith, R. A. (Ed.) The Lost Memoirs of Edgar Cayce. Virginia Beach, VA: A.R.E. Press.

Stearn, J.  Edgar Cayce: The Sleeping Prophet.  New York: Bantam Books.

Sugrue, T.  There is a River.  New York: Holt, Rinehart and Wintson.

The Edgar Cayce Readings:

Cayce, E. The Complete Edgar Cayce Readings on CD-ROM. Virginia Beach, VA: A.R.E. Press.

Overviews of the Cayce Approach to Health and Healing:

Mein, E.  Keys to Health: Holistic Approaches to Healing.  St. Martin's Press: New York.

Reilly, H. & Brod, R.  The Edgar Cayce Handbook for Health Through Drugless Therapy.
Virginia Beach, VA: A.R.E. Press.

Other Resources:

Carricato, J.  Edgar Cayce's Health, Healing & Diet.  Virginia Beach, VA: A.R.E. Press.

Duggan, J. & S.  Edgar Cayce's Massage, Hydrotherapy & Healing Oils. Virginia Beach, VA: Inner Vision Publishing Company.

Duggan, S.  Edgar Cayce's Guide to Colon Care. Virginia Beach, VA: Inner Vision Publishing Company.

Karp, R.  Edgar Cayce Encyclopedia of Healing.  New York: Warner Books.

McGarey, W.  The Oil That Heals: A Physician's Successes with Castor Oil Treatments.
Virginia Beach, VA: A.R.E. Press.

McGarey, W.  The Edgar Cayce Remedies.  New York: Bantam Books.

McGarey, W.  In Search of Healing.  Virginia Beach, VA: A.R.E. Press.

McMillin, D.  The Treatment of Schizophrenia. Virginia Beach, VA: A.R.E. Press.

McMillin, D.  The Treatment of Depression. Virginia Beach, VA: A.R.E. Press.

McMillin, D.  Living Nightmares: Case Studies in Anxiety (Based on the Readings of Edgar
Cayce).  Virginia Beach, VA: Lifeline Press.

McMillin, D.  An Alternative Perspective: Alzheimer's Disease and the Dementias.  Virginia
Beach, VA: A.R.E. Press.

McMillin, D. & Richards, D.  The Radial Appliance and Wet Cell Battery.  Virginia Beach, VA:
Lifeline Press.

McMillin, D.  Principles & Techniques of Nerve Regeneration.  Virginia Beach, VA: A.R.E.
Press.

McMillin, D.  Case Studies in Depression.  Virginia Beach, VA: A.R.E. Press.

McMillin, D.  Case Studies in Schizophrenia.  Virginia Beach, VA: A.R.E. Press.

Pagano, J.  Healing Psoriasis: The Natural Alternative.  Englewood Cliffs, NJ: The Pagano
Organization.